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Protect Your Lifestyle
OMA Priority Insurance Program (OPIP)

OMA Priority Insurance Program (OPIP)

We're ready to help.

 

 

http://www.omainsurance.com/Products/Product Documents/SM-204.pdfForm-OPIP--Pre-Authorized Debit Form (Banking Change)
http://www.omainsurance.com/Products/Product Documents/EHC-HSA-50131-E (G5842-E).pdfForm-OPIP-Extended Health Care and Health Spending Account Claim Form
http://www.omainsurance.com/Products/Product Documents/OPIPEHCClaimForm.pdfForm-OPIP-Extended Heath Care Claim Form
http://www.omainsurance.com/Products/Product Documents/DENT-HSA-50131-E (G5846-E).pdfForm-OPIP-Health Spending Account Claim Form (for Dental claims only)
http://www.omainsurance.com/Products/Product Documents/Form-OPIP-LifeEventChange.pdfForm-OPIP-Life Event Change Form

You can’t plan for everything*

*B​ut you can be p​repared w​​ith OPIP​​​

​​​

Make protection a priority with the OMA Priority Insurance Program (OPIP).

OPIP is designed to provide you and your family with unique protection solutions including Health and Critical Illness insurance, Legal Expense Insurance and Security Evacuation Coverage. If you are an Eligible Physic​ian ​(see Eligibility tab), OPIP's strong foundation of coverage is available to you for an annual contribution of only $200. You can also top up with additional self-funded coverage options that can be customized to your needs – all in one highly affordable package.​​

What's included

The OMA Priority Insurance Program (OPIP) was designed to ensure that Ontario physicians have access to the type of benefits that many Ontarians receive as part of an employee benefits program.

OPIP includes Health Coverage or a Health Spending Account and Critical Illness coverage under the Physicians Health Benefit Program (PHBPiPHBP is a government subsidized benefit program for Ontario doctors.
See OPIP Subsidy tab.
) as well as Legal Expense Insurance (LEI), and Security Evacuation Coverage (SEC).

Health

Health coverage will ensure that you and your family are covered for health-related services not covered by the Ontario Health Insurance Plan (OHIP) - including eligible drugs, hospitalization, paramedical services, assistive devices and more. Enjoy the added convenience of a pay-direct drug card as well as $2-million emergency out-of-country travel coverage. If you wish to upgrade your coverage at additional cost, Health Plus and Dental coverage is available as well.

If you already have Extended Health Care coverage, you can easily opt out of OPIP Health and receive a Health Spending Account - flexible credits to pay for health services important to you and your family including some insurance premiums, vision and dental expenses. How you spend the credits is up to you – as long as the expenses qualify as a medical, dental or hospital expense under the Income Tax Act (Canada).

Critical Illness (CI)

OPIP coverage also includes a Critical Illness benefit of up to $50,000 lump sum payment,1 if, after the effective date, you are diagnosed with or have surgery for one of the 25 covered conditions.

At time of initial OPIP enrolment, OMA members can also purchase an additional $50,000 each for coverage for themselves and their spouse – with no medical evidence required.


1Based on the current tax laws, the cash benefit from a group critical illness insurance plan will not presently be taxed when the premiums are paid for by you and the benefit is payable to you. Diagnosis of a critical illness, such as cancer, heart attack or stroke must occur after the effective date of coverage and you must complete a Survival Period (usually 30 days).

Legal Expense Insurance (LEI)

Legal Expense Insurance, provided by DAS Canada, protects you, your spouse and children living at home from unexpected legal issues. From small claims court disputes, to highway traffic violations, legal disputes can have a significant impact on your time and finances.

Have a personal legal issue and need to talk to an advice lawyer? Call 1.855.953.1433 from 8:00 a.m. to midnight, seven days a week. If you have questions about your coverage, please contact us at 1.800.758.1641 or email info@omainsurance.com.

Security Evacuation Coverage (SEC)

Global Security Evacuation Coverage provided by Drum Cussac through Chubb Life Insurance assists you and your family while travelling outside of Canada, for either business or leisure travel, to be evacuated to the nearest place of safety in the event of a hostile or dangerous situation.

Register your itinerary with the Overwatch program and get additional peace of mind that if a travel alert is issued, you will be notified. State-of the-art services allows you to check the situation before, during and after your trip and be monitored and supported anywhere in the world at any moment, with over 200 languages spoken at Drum Cussac's 24/7 crisis response centre.


Members can also upgrade their coverage with Optional Self-Funded (OSF) benefits such as Dental Care.

Optional Self-Funded Coverages (OSF) - Member Paid

OMA Insurance recognizes that doctors sometimes want their coverage to go beyond basic protection and offer more comprehensive coverage that includes enhanced benefits for themselves and their family. For this reason we offer exclusive optional upgrades which, when added to OPIP, go beyond basic coverage to offer added protection.

Your Subsidized
Coverage
You can purchase these
Optional Self-Funded Coverages
Health
Plus
Dental Dental
Plus
Additional
Critical Illness
Health & Critical Illness
(under age 65)
Health
(age 65 and over)
-
$350 Health Spending
Account (HSA) &
Critical Illness
(if opted out of Health and
under age 65)
-
$500 HSA
(if opted out of Health and
under age 65)
- -


OPIP Simplified

OPIP is designed for you and your family to provide a strong foundation of coverage for an annual contribution of $200.

Here are a few examples that we’ve prepared to help explain some of the various coverages and subsidies.

OPIP Subsidy

As an Eligible Physician, your annual contribution to OPIP is only $200, plus the cost of whatever optional self-funded coverages (OSF) you may have selected.


Cost

The actual cost of your OPIP coverage is much higher than your annual contribution and is calculated based on gender, family status, age, and smoking status. The difference between the true cost of OPIP and your annual contribution is paid for in two ways.

Government Subsidy

Physicians Health Benefit Program (PHBP) is a program subsidized by the Ontario government through Ontario Physicians Services Inc. (OPSI), a wholly owned subsidiary of the OMA established solely to administer this government subsidy, to help provide Eligible Physicians with Health insurance (or a Health Spending Account) and Critical Illness insurance.

PHBP is included in OPIP and, if you are an Eligible Physician, a portion of your OPIP contribution is designated toward PHBP. $50 of your annual contribution is collected at the direction of OPSI to help pay for your PHBP benefits. The balance of your PHBP premium (that is, all but $50) is paid through the government subsidy, up to a maximum set in the OPSI agreement. The government-funded amount may need to be reported as income for tax purposes on your income tax return.

For a more detailed explanation of the tax implications, visit the Tax Considerations page.

OPIP Reserve

Under the supervision of the OMA Board Insurance Committee, the OPIP Reserve provides for LEI and SEC coverages and accumulates funds for future use. If the PHBP government subsidy maximum (set in the OPSI agreement) is exceeded, the OPIP Reserve will also contribute to paying for PHBP.


For both Eligible and Non-Eligible Physicians optional self-funded coverages (OSF) are charged at actual cost.




Calculate the value of your annual contribution






For calculation of Critical Illness Insurance
















Frequently Asked Questions Regarding OPIP

Eligibility

To access OPIP without having to answer medical questions, you must enrol within 90 days of your initial OPIP offer. If you do not choose to participate in OPIP within 90 days of receiving your initial offer, you can apply at any time with medical evidence.

If you are an Eligible Physician, the government subsidized Physician Health Benefit Program (PHBP) helps pay the cost of your critical illness insurance and health coverage (or HSA if you opt out of the health coverage) provided through OPIP. You are an Eligible Physician if you are:

  1. A member in good standing of the Ontario Medical Association or, if not a member, have paid all dues and assessments owing under the Ontario Medical Association Dues Act, 1991;
  2. Registered with the College of Physicians and Surgeons of Ontario and have acquired an independent practice license;
  3. Engaged in providing medical services in the province of Ontario for at least 15 hours per week on average.
  4. Residing in Canada. Residents of Quebec are eligible if
    • they practise in Ontario;
    • the enrolment/application form is signed in a province or territory other than Quebec; and
    • they agree that the certificate of insurance and all other communications will be delivered in a province or territory other than Quebec.

Newly Eligible Physicians

If you are not currently enroled in OPIP and are a newly practicing physician, an
enrolment form will be sent to you. A newly practising physician includes:

  • An OMA member beginning to practice in Ontario
  • A newly graduating resident who has become a practising physician in Ontario

You will be eligible to enrol without medical evidence within 90 days from the date you receive notification of your eligibility. After this date, medical evidence will be required in order to apply.

Physicians Returning to Work

If you were ineligible at the time of initial offer, you may be eligible to enrol for OPIP without medical evidence if you are returning to work from:

  • Parental leave of absence
  • Total disability
  • Residual disability, or
  • Opting out because you moved to another province to practise and have now returned to Ontario

Physicians Not Currently In OPIP ("Late Entrants")

If you did not enrol in OPIP when initially eligible, you may be eligible to apply for OPIP but you will be required to provide medical evidence.

If you are currently enroled in OPIP and become ineligible

Changes in Your Life Requiring Notice

Please remember that once you are enroled in the program you must notify the program administrator, Sun Life, if you are:

  • No longer residing in Canada
  • No longer registered with the College of Physicians and Surgeons of Ontario
  • No longer providing medical services in the province of Ontario for at least 15 hours per week on average; or
  • Absent from practice for more than one year due to a parental leave of absence or disability

Subsidy through Physician Health Benefit Program (PHBP)

If you no longer qualify for government subsidization you may be permitted to continue your coverage (with the exception of the Health Spending Account) on a non-subsidized basis. You are required to notify the program administrator to obtain approval to continue coverage on a premium paying basis, or to discontinue your participation in OPIP.

If at a later date you meet the basic eligibility requirements and have continued paying the premiums so that your coverage was maintained consistently, you may become eligible to re-applyfor government subsidization.

Contact the program administrator at 1.800.758.1641 or info@OMAinsurance.com.

Get OPIP

OMA Insurance works to streamline the application process as much as possible, reducing the complexity and time required to arrange coverage. Answer the following question to get started.

Have you received your OPIP offer within the last 90 days?

You are eligible to enrol in OPIP without medical evidence within 90 days from the date you receive notification of your eligibility.

Get OPIP in 3 easy steps:

1

Complete your Enrolment Form

No medical evidence is required if you enrol within 90 days of receiving your OPIP offer. Complete the Enrolment Form and send it to OMA Insurance.
2

Received by Administrator

The forms are received by Sun Life, Administrator of the OMA Plan.
3

Receive your Certificates

Once your payment has been received, your Certificate of Insurance will be sent to you.


Enrol Now

If you did not enrol in OPIP when initially eligible, you may be eligible to apply for OPIP but you will be required to provide medical evidence.

Get OPIP in 3 easy steps:

1

Complete your Application Form

Complete a Late Entrant Application which includes medical questions and send it to OMA Insurance.
2

Received by Administrator

Sun Life will review your application and may contact you for further information. Learn more about what you can expect during the underwriting of your application.
3

Receive your Certificates

Once your payment has been received, your Certificate of Insurance will be sent to you.


Apply Now